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The doctors’ case for homeopathy

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The UK government is under pressure to ban homeopathic remedies within the National Health Service, but the NHS needs more homeopathy, say Britain’s 400 GPs who currently prescribe it. WDDTY’s editors investigate

Ever since the birth of the UK’s National Health Service in 1948, homeopathy has been an integral part of the medical care offered by general practitioners (GPs) and hospital doctors. Costing a tiny fraction of the NHS’s overall drug bill—£4 million (US $5.3 million) out of £113 billion (US $150 billion) last year—homeopathic remedies have offered any NHS doctor who cared to do extra training a clinical alternative to the monoculture of pharmaceutical drugs. Some 400 doctors who took the training now offer homeopathy in addition to standard medical care.

But this option is now under threat, largely as a result of a decade-long propaganda campaign mounted by a small band of British ‘skeptics’ who have lobbied the UK government to ‘blacklist’ homeopathic remedies.

They maintain that the laws of science mean homeopathy cannot work and that the evidence proves it. The most high-profile condemnation of the 200-year-old system of medicine comes from a small group of British Members of Parliament (MPs). In 2010, their Science and Technology Committee report recommended withdrawing homeopathy from the NHS and banning any further homeopathic research—two recommendations the government rejected.

Interestingly, the committee’s most vitriolic opponents of homeopathy were MPs with a background in conventional medicine. Indeed, from the very beginning, there’s been a turf war between two opposing medical systems: the pharmaceutical doctors and the homeopathic doctors.

More than nothing

Homeopathy is particularly singled out because its principles seem downright irrational. Its ultra-low doses are prepared by ‘serial dilution’ in water—adding a drop of the original medicine to 100 drops of water, then taking a drop of that diluted mixture and adding yet another 100 drops of water, and so on.

At each stage of dilution, the liquid is vigorously shaken in a process called ‘succussion.’ The step-by-step dilution often continues to the point where the liquid may be a staggering 1,000,000,000,000,000,000,000,000 times more dilute than the original starter medicine—thus eliminating every trace of it. Yet homeopaths say such extreme dilutions not only work, but actually work better than the original medicine.

“If we were to accept the principles of homeopathy, we would have to overturn the whole of physics and chemistry,” says Professor Colin Blakemore, head of Britain’s Medical Research Council, echoing the prevailing view. Others are much blunter.

This kind of invective means it’s a dialogue of the deaf, says Noel Thomas, a GP in South Wales. “Opponents make much of the ‘consistent failure to demonstrate effect beyond placebo’ when trials of homeopathy are studied; this is untrue. It is depressing to see the interests of patients being threatened by a small posse of poorly informed and discourteous critics, who mix a little science with denigration and abuse,” he says.

“Only a very few critics confine themselves to what they regard as scientific principles—people who believe that science knows everything about everything, and nothing remains to be explained—scientific ‘fundamentalists,’ perhaps.”

Dr Thomas has put his finger on the nub of the issue.

The war is not about evidence, but scientific ideology. Because homeopathic medicines often contain not a single molecule of an active ingredient, opponents mock them as an affront to rationality—and indeed, a threat to the whole of science (see box, page 44). Hence the hostility from lobbying organizations such as the self-styled Sense About Science and The Good Thinking Society (a name eerily close to Orwell’s dystopian “Ministry of Truth”), whose attacks echo those of the medieval Vatican against Galileo: it cannot be true, so it’s not.

Real-life evidence

GPs who prescribe homeopathy acknowledge that their medicines’ mode of action is difficult to explain scientifically, but they cannot deny the often startling evidence of their own eyes.

Andrew Sikorski, a GP in a group practice in East Sussex, tells of a powerful experience at the end of his NHS homeopathic training in the 1990s. “I was a locum in ENT surgery at a hospital in Winchester when I was called late one night to see a male patient who arrived as an emergency with an advanced case of quinsy [a rare complication of tonsillitis]. His throat was almost completely blocked by a large abscess, and he could barely swallow his own saliva. He was very ill, with a high temperature and rapid pulse. The GP had prescribed a week of oral antibiotics, which clearly had failed.

“The correct emergency treatment was intravenous antibiotics and lancing of the abscess. However, I happened to have a first-aid homeopathic kit in my white coat pocket. To my barely tutored eye, the patient’s presentation indicated the homeopathic medicine Belladonna—fortunately part of the kit.

“With the consent of the patient and his partner, I popped a Belladonna pill into his mouth before going off to prepare the intravenous drip. I returned a few minutes later and was astounded to see the patient sipping water and talking freely. Both his pulse and temperature had reverted to near-normal and, on examination, there was no abscess whatever—just a red flush in the area of the right tonsil where the abscess had been. That extraordinarily rapid and complete response was well-nigh miraculous: no conventional treatment could have achieved anything like it.”

Of course, such stories can be dismissed as examples of a particularly dramatic placebo effect or even coincidence, but they’re not uncommon. Consider the case from Brian Kaplan, another conventionally trained doctor. “I was treating a middle-aged woman for osteoarthritis, using the homeopathic remedy Arg Met 6, one dose daily. She had been delighted with the results and needed no conventional painkillers. Then, at one of her regular six-month checkups, she announced with great disappointment that the remedy was no longer working, and the pain was back with a vengeance.

“On a whim, I asked if she happened to have the medicine bottle with her. On close inspection, I saw that it said Arg Nit 6—a very different remedy.

“I realized that this was an ideal opportunity to test the efficacy of homeopathy beyond the placebo effect. So, without sharing any of this information with the patient, I made out a repeat prescription, ensuring this time it clearly was Arg Met 6 . . . I heard nothing more from the patient until her next six-month visit. She had a smile on her face . . . because once again she was free from pain. The correct homeopathic medicine had worked, whereas the incorrect remedy had failed—all without the patient’s knowledge.”

In 2006, Tom Robinson, a Dorset GP who offers both conventional medicine and homeopathy, published a 12-month audit of his homeopathic treatments.2 His records showed that he used them for roughly one in 10 patients, the top conditions treated being ear, nose and throat problems, mental health issues, skin disorders and “miscellaneous, such as ‘tired all the time,’ bruising, motion sickness, leg cramp, chilblains—all situations,” he says, “where conventional medicine has nothing to offer.

“An analysis of the responses to the homeopathic medicines revealed that 78 percent of my patients noted an improvement following treatment, even when prescribed in a standard 10-minute GP consultation.”

Only 3 percent of his patients found their condition worsened following treatment—a figure far lower than the percentage of patients who get worse with conventional drugs. “Occasionally, patients can experience an aggravation of their symptoms at a stage of their treatment, so this was not an unexpected finding,” says Dr Robinson.

His survey ties in with official NHS audits. For example, Dr Sikorski’s East Sussex practice, like all such practices, is required to undergo regular monitoring. “These independent audits show that my prescribing costs are lower than those of my pharma-only colleagues and that I make fewer hospital referrals,” he says.

“Homeopathic medicines appear particularly effective at the extremes of age. Infants respond very rapidly with the correct remedy, and seniors with chronic ailments can be given safe, effective and good-value one-time homeopathy instead of costly repeat prescriptions of pharmaceutical medicines.”

Accepted on the continent

The practice records of doctors like Sikorski and Robinson match the evidence from Europe, which has many thousands more homeopathic GPs than Britain does. There, studies have shown that primary-care practices offering homeopathy have better patient outcomes than pharma-only practices, and often at lower cost.

One area where homeopathy has scientifically proved more effective than conventional drugs is with upper respiratory tract infections like flu, coughs, colds and sore throats. These ailments, which represent the most common reasons for primary-care visits, are a major cost to the NHS. Many GPs prescribe antibiotics for such conditions, even though they know it’s bad medicine, simply to get the patient out the door. By contrast, properly trained GPs can choose an appropriate homeopathic remedy, now shown to be effective according to ‘outcome studies’.

Opponents of homeopathy claim such studies are worthless as they cannot exclude either the placebo effect or the fact that many conditions are ‘self-limiting’—in time, patients get better anyway.

The only way to establish whether homeopathy really works, they say, is through randomized controlled trials (RCTs) testing a homeopathic pill against an identical-looking placebo.

According to British pressure group Sense About Science, “over 150 clinical trials have failed to show that homeopathy works. Some small-scale studies have yielded positive results, but this is due to poor methodologies or random effects”—claims strongly contested by scientific researchers within homeopathy (see below).

But over the past decade, conventional medicine itself has come under fire for having an equally poor evidence base. The first high-level critic was Dr Marcia Angell, formerly editor of the prestigious New England Journal of Medicine who, in 2005, made the astonishing claim: “It is simply not possible to believe much of the clinical evidence that is published.”3 Two years later, the BMJ agreed, publishing a survey showing that only 15 percent of NHS treatments were definitely “beneficial” and 22 percent “likely to be beneficial,” leaving the vast majority to be of “unknown effectiveness” or “likely to be ineffective.”4

A year ago, Lancet Editor-in-Chief Richard Horton reported on a closed-door Wellcome Trust conference in which medical science was pilloried for “questionable research practices,” “many a statistical fairy tale” and “a research culture that occasionally veers close to misconduct.”

As a result, says Horton, “much of the scientific literature, perhaps half, may simply be untrue.”5

Of course, the fact that pharmaceutical medicine has a poor evidence base doesn’t necessarily make a stronger case for homeopathy.

Indeed, last year, the UK government was pressured by lobbyist Simon Singh, founder of the Good Thinking Society and a trustee of Sense about Science, who threatened a ‘judicial review’ to blacklist homeopathic medicine—and the government appears likely to capitulate.

“Why should homeopathy be singled out?” asks Dr Kaplan. “To use evidence-based medicine to attack homeopathy exclusively and call for legislation against it, while huge swathes of conventional medicine lack evidence, is rather strange behavior,” he says. “Double standards? That would be putting it euphemistically.”

The primary concern of Singh and his fellow sceptics is the so-called ‘anti-science’ message that homeopathy sends out. “The overwhelming majority of real doctors think homeopathy is pseudoscience,” says Singh. “After all, homeopaths typically dilute their remedies until they contain no actual ingredients.”

But evidence is mounting that homeopathy’s high dilutions may well have scientific explanations (see box, page 44). Furthermore, it’s becoming increasingly clear that homeopathy has genuine benefits in a range of biological systems—not just human, but animal, plant and even cellular ones.

It’s been successfully used in veterinary medicine and agriculture, as well as in laboratory tests on body cells (see box, page 49). All of this non-human evidence inherently rules out the dismissive ‘placebo-effect’ explanation.

Much of the data have come from places like Brazil and India, where homeopathy is welcomed as a valuable part of their national healthcare systems. In India, homeopathy is taught in universities and medical schools, sending thousands of qualified doctors every year out into hospitals and the community, and carrying out clinical trials on a range of chronic conditions, including cancer.

By the end of 2014, homeopathy had been tested in 104 RCTs for 61 different medical conditions: 41 percent were positive; 5 percent were negative; and 54 percent were inconclusive.6

This track record is strikingly similar to conventional medicine’s. A 2007 analysis of a “large random sample” of RCTs of conventional treatments revealed that 44 percent were ‘likely to be beneficial,’ 7 percent were ‘likely to be harmful’ and 49 percent were inconclusive.7

Clearly, both homeopathy and conventional medicine are on a par with each other when it comes to evidence-based medicine (EBM)—the foundation of medical practice.

Why are RCT results so patchy? For some experts, it’s not that treatments are necessarily ineffective, but that RCTs themselves have severe limitations. Every year, a staggering 18,000 RCTs of conventional medicine are published, but because of a “paucity of high-quality evidence,” most of them have “little meaning or value for informing clinical practice,” says the Office of Research Integrity in Maryland.8

“Even if RCTs show a benefit, they often do not give sufficient insight into harms,” says Professor Jan P. Vandenbroucke of Leiden University. “A properly balanced review should include a systematic evaluation of adverse effects.”9

According to Professor Sir Michael Rawlins, head of the Medicines & Healthcare Products Regulatory Agency (MHRA), Britain’s official medical regulatory body, RCTs “should be replaced by a diversity of approaches that involve analyzing the totality of the evidence base.”10

That view is shared by the late Professor David Sackett, widely regarded as one of the fathers of clinical epidemiology: “Evidence-based medicine is not restricted to RCTs and meta-analyses,” he wrote 20 years ago. “It involves tracking down the best external evidence with which to answer our clinical questions.”11

Patient-centered outcomes

Given the problems with RCTs in general and the scandalous unreliability of drug trials financed by the pharmaceutical industry, the US Congress recently authorized the Patient-Centered Outcomes Research Institute (PCORI) to look at medical outcomes in real-world situations. Its job is to ask: Does treatment X result in healthier patients?

Support for PCORI’s approach has come from the independent Cochrane Database, which recently showed that, while RCTs and outcome studies often differ in their conclusions, there’s no difference in quality of evidence.12

When PCORI principles are used to assess homeopathy, the results are clear: homeopathy consistently outperforms conventional medicine. Most of this outcome research has been done in Europe, where homeopathy is more closely integrated into national health services than in Britain.

For example, in 2008, over a hundred homeopathic GP practices in Germany and Switzerland took up the challenge of demonstrating the health of “chronically ill patients after eight years of homeopathic treatment.” The results were outstanding: “disease severity decreased significantly” and “physical and mental quality of life scores increased considerably.”13

This may be one reason why the Swiss government has announced that, in May 2017, homeopathy will be given the same status as conventional medicine when it comes to health insurance.

Homeopathy is particularly invaluable for people with a constellation of health issues—the so-called ‘multimorbid’ patient. A University of Bern study monitored the results of homeopathic treatment given to 50 such patients, and found a 91 percent improvement within 12 months—for less than half the estimated cost of conventional medicine.14

In addition, a head-to-head comparison of conventional and homeopathic care in a German GP practice found that patients were 25 percent more satisfied with homeopathy—as were the doctors, particularly with outcomes in children.15

In Belgium, a random audit was made of the records of every patient who visited 80 homeopathic GP practices on a single day in 2004. Most of the patients had previously received conventional medical treatments (which many said had made their problems worse), and the vast majority (89 percent) now thought homeopathy “had improved their physical condition.”

As the Belgian researchers concluded: “Costs of homeopathic treatment were significantly lower than conventional treatment [by about a third], and many previously prescribed drugs were discontinued.”16

This matches the experience of Britain’s few homeopathic hospitals, whose patients tend to suffer what many doctors scornfully dub ‘thick note syndrome,’ reflecting a long history of failed treatments for baffling conditions.

In such cases, PCORI-type research once again reveals solid benefits from homeopathy. A six-year study of more than 6,500 patients attending the homeopathic outpatients unit in a Bristol NHS hospital found that 71 percent of them reported “positive health changes.”17

Facing extinction

However, after 70 years of being part of the NHS, homeopathy now faces extinction. Already, under pressure from PR-savvy opponents, three homeopathic hospitals have closed, and many local primary care trusts are no longer funding homeopathic referrals.

The leaders of UK homeopathy have seemed powerless to stem the tide of hostility, even though homeopathy—with its zero side-effects and arguably adequate reliability—should be able to mount a substantial challenge to conventional drug-based medicine. After all, to quote one of the self-styled experts in alternative medicine:

“We should remember an important foundation of health care: the precautionary principle. It compels us to use, whenever possible, only those therapies which demonstrably generate more good than harm.”18

Who said this? Ironically, no less a figure than that arch-critic of homeopathy, Edzard Ernst.

More than just water

The principal objection to homeopathy is that so many serial dilutions in water mean that the final product must be nothing but water.

But this turns out to be false. Over the years, subtle but measurable differences between ultra-diluted homeopathic liquids and plain water have been identified by a wide variety of laboratory tests, including: UV spectroscopy (ultraviolet light is used to identify subtle color differences);1 nuclear magnetic resonance spectroscopy (magnetic field differences);2 thermoluminescence (heat differences using laser measurements);3 high-voltage plasma visualization (differences in response to a high-energy spark);4 solution conductivity (differences in electrical resistance);5 and solvatochromicdyes (differences in the way dyes bind to homeopathic solutions).6

So there is clearly something ‘in’ homeopathic dilutions, even when nothing of the starter substance should theoretically be present.

What’s the explanation?

The two front-running possibilities include:

Electromagnetic communication in cells

The late French immunologist Jacques Benveniste first proposed that homeopathic remedies retain an electromagnetic ‘memory’ of the starter substance, thereby generating a non-chemical electrical signal that affects a patient’s body cells.

His basic theory was subsequently confirmed by Nobel laureate Professor Luc Montagnier, whose experiments have demonstrated that DNA “signals” are retained in water even after successive dilutions.7

The activity of nanoparticles

These are extremely tiny particles of a substance no bigger than a particle of smoke. They are of growing interest to the pharmaceutical industry—for example, to deliver drugs to solid tumors. Using electron microscopy, researchers have detected the presence of nanoparticles in homeopathic liquids even after an exceptionally large number of serial dilutions.8

Nothing to sneeze at

Although upper respiratory tract infections (URTIs) like coughs, flu and colds often clear up by themselves within a few weeks, they are responsible for most doctors’ visits across the developed world. Outcome studies consistently show that homeopathy is superior to conventional treatments for URTIs in terms of patient health or cost, or both.

In France, where around 95 percent of GPs prescribe at least one homeopathic remedy a year, a 12-month study found that while homeopathy and conventional medicine were equally effective, the prescription costs of the latter were nearly twice as high.1

In Italy, where homeopathy is increasingly being integrated into regional health systems, a homeopathic cough remedy worked significantly better than a placebo.2 Another study in Lucca’s Homeopathic Clinic showed a 42 percent reduction in prescribing costs for homeopathy compared with a 9 percent increase in conventional drug costs.3

In Germany, where around 20 percent of doctors prescribe homeopathy, the remedy Gripp-Heel was “successful” in reducing URTI symptoms in 78 percent of cases vs. 52 percent with conventional treatments.4

A 2007 comparative study of more than 1,500 patients in GP practices in eight separate countries (including the UK and US) found that, within the first week after treatment, URTI symptoms cleared up faster with homeopathy than with conventional drugs. Doctors chose from more than 60 different homeopathic preparations to suit the individual patient, whereas the conventional armory had only four treatments: antibiotics, nasal sprays, cough mixtures and painkillers.5

Genuine or placebo effects?

Opponents of homeopathy claim that any clinical benefit must be due to a placebo effect, where the patient’s belief in the therapy stimulates a natural healing response.

But homeopathic remedies have repeatedly been shown to have measurable effects on non-human biological systems, which inherently rules out the placebo effect. In Europe, homeopathy is being increasingly used on organic farms, where pharmaceutical drugs are discouraged byEU regulations.

• When scientists from the University of Bern in Switzerland tested one of them, BIPLANTOL, against the plant pathogen Pseudomonas syringae in a randomized blinded trial, the homeopathic remedy killed about 20 percent of the pathogenic bacteria compared with an inert spray—a significant benefit, albeit less than the 40 percent efficacy of conventional (but harmful) chemicals.1

Animals

In Brazil, dairy cows are often plagued with cattle ticks. Conventional pesticides do work, but they need repeat applications every two weeks, thus rapidly inducing insect resistance; they also leave harmful residuesin the milk.

Brazilian company Nutriphós makes a range of homeopathic animal health products, one of which is specifically formulated to interfere with cattle-tick reproduction (Ectoderm). The treatment is usually added to the cows’ daily salt supplements.

• Paranaense University scientists reported the results of a two-year-plus study in 2010. The treatment “significantly decreased . . . the reproductive efficiency of ticks,” eventually resulting in full eradication of the ticks in treated animals, so pesticides were no longer required.2

• At the Veterinary Research Institute in Izatnagar, India, a remedy comprising Phytolacca, Calcarea fluorica, Silica, Belladonna, Bryonia, Arnica, Conium and Ipecacuanha (VT-6) was tested against antibiotics in a study of mastitis (udder infection) in dairy herds. VT-6 had a “cure rate” of 87 percent vs the drugs’ much less impressive 59 percent—which were around seven times more expensive, too.3

Laboratory studies

• When researchers at the MD Anderson Cancer Center in Texas took cancer cells from human breast tumors and exposed them to four “ultra-diluted remedies” commonly used in India to treat breast cancer, two showed potent anticancer effects, causing both cell “arrest and apoptosis” (natural cell death).4

• Zoologists at the Parasitology Laboratory of Panjab Universityin India infected mice with a virulent malaria parasite, then treated them with two homeopathic remedies, one of them a highly diluted solution made from the parasite itself (like a vaccine). Treated mice survived an average of three weeks, whereas untreated ones died within eight days.6